Lessons from the Graham Sessions: 4 Things PTs Must Do Now

As a physical therapist, it’s easy to get caught up in the day-to-day demands of treating patients and—for those of us who double as clinic owners and directors—running a business. It’s not often that we get to step back and think about our profession as a whole—to thoughtfully consider all of the issues and challenges facing physical therapists. And opportunities to have meaningful discussions about those topics are even fewer and farther between. That’s what makes the Graham Sessions so unique, and I was honored to not only attend this year’s meeting in Savannah, Georgia, but also present on the subject of EMR technology.

If you’re not familiar with this annual event, the basic format is a series of informal presentations on a variety of hot topics, with an open discussion period following each presentation. All in all, there were more than 100 attendees at this year’s meeting. Compared to other industry conferences, that might sound like a small crowd, but the intimate atmosphere plays into the overall purpose of the meeting. Now in its eighth year, the event originally began as a roundtable with a handful of PTs who wanted to have real, honest, off-the-record conversations about their industry. In keeping with that spirit, organizers ask that, if attendees choose to share any of the ideas or opinions they hear during the sessions, they do so without quoting specific people by name. That way, everyone can voice their thoughts without fear of public backlash. And while I unfortunately saw this ground rule being broken on social media, I have personally pledged to abide by it in all communications and discussions pertaining to the Graham Sessions—including this blog post. That said, here are some of the key lessons I took away from this year’s meeting—things I would challenge all of my PT peers to do as we work to evolve the profession in 2015 and beyond:

1. Rethink the status quo.

Physical therapists have the power to be major disruptors in the healthcare world, but to drive disruption at scale—outside of our own clinics, cities, and states—we all have to be willing to abandon everything we think we know about our businesses and our positions within the healthcare community at large. This can be as simple as reconsidering the way your front office works. Perhaps there are systems you could automate or technologies you could employ to improve efficiency and cut down on wasted time.

Once you get comfortable making small changes, push yourself to think bigger. For example, many PTs direct the majority of their marketing efforts—and budget—toward targeting physicians. And while that may benefit you at the clinic level, it doesn’t have much of an impact outside of your own walls. To effect real change in the industry—to truly disrupt the status quo—we have to get more creative than that. We have to think outside of the box. Consider this: workers’ compensation is a $250 billion industry. That’s billion—with a B. How can we get a bigger slice of that pie? Well, what if we went directly to the employers—the people with a true financial stake in workers’ comp—and showed them how much money they would save by offering plans that allow for more coverage of physical therapy services?

And of course, no discussion of disruption would be complete without a mention of technological innovation—specifically, telehealth, which has the potential to completely revolutionize the way we provide treatment. One tech trend that PTs are particularly poised to integrate into their care models: wearables. There are therapists out there who have already started capitalizing on health monitoring devices like Fitbits and Jawbones to add to, or enhance, the services they provide. These technologies could give us a very effective “in” at the consumer level—and that’s a huge opportunity for us. But, we have to seize that opportunity now, and that means having the courage to lead—to be proactive, rather than just reactive. If we, as a unified profession, can embrace that mode of thinking, then we’ll not only disrupt the status quo of the PT industry—we’ll change the face of health care overall.

2. Redefine our value.

In addition to reconsidering the way we do things, we need to reconsider the way we think of ourselves—particularly with respect to the value we offer. Traditionally, we’ve always talked about the value of our care in terms of quality and cost. Here’s what that definition looks like in a mathematical format:

Value = (Clinical Outcomes + Patient Satisfaction) ÷ Cost of Care

But this formula fails to incorporate two of the most important pieces of the value puzzle: patient access and long-term savings. These factors are especially relevant to PTs because:

  1. Direct access is now a reality in all 50 states, and that exponentially increases our value because our services are now readily accessible to so many more people.
  2. We create downstream savings every time a patient seeks our services instead of turning to more costly interventions such as surgery or pharmaceuticals.

So really, the value equation should look more like this:

Value = (Clinical Outcomes + Patient Satisfaction + Access to Care) ÷ (Cost of Care – Savings Delivered)

Of course, we also have to keep in mind that at the end of the day—regardless of whatever value equation we come up with—our patients are the ones who truly define the value of the care they receive. And their definition of what is valuable might not match up with ours. To them, “value” might be as simple as “not having pain”—and if we’re going to capitalize on the consumer market that direct access has created, we have to figure out ways to deliver that value.

3. Take control of our data.

“Data” has become a huge buzzword in the healthcare community. And while there’s no denying that collecting outcomes data is becoming more crucial by the minute, we have to understand that collecting data simply for the sake of collecting data isn’t going to get us anywhere. Instead, we have to go about gathering our data with a clear vision of how we will interpret and use that data. In other words, we can’t get so caught up in finding the answers that we forget to ask the questions—because asking the right questions is the first step in making the information we collect meaningful.

Now, I know there are a lot of PTs out there who are already collecting outcomes data. That’s a huge step in the right direction, but many of those providers are only using that intelligence within their own clinics. I’m not saying that’s necessarily bad—in fact, I think it’s great that PTs are using data to improve their marketing efforts, monitor employee productivity, perform quality assurance assessments, inform care plan creation, and negotiate better payer contracts. But I think we’re missing the boat by keeping our data siloed in our individual clinics. Just think of the power we’d have if we pooled all of our information together. Not only that—think of the control we’d have over our own destinies.

Historically, many in our profession have looked at so-called “aggregated data” in a negative light, mostly because they see it as something insurance companies could use against us. But with reimbursements for physical therapy services continuing to fall, it’s clear we have to do something different if we want to change the status quo, and I believe that “something” is presenting payers with meaningful data that communicates a message they can’t ignore—and the more data, the stronger the message.

4. Stop being afraid of standardization.

For decades, PTs have rallied around a common cry for autonomy. We resisted anything that might threaten our capacity to think and practice independently—including standardization. The problem is, the lack of standardization in our industry has given way to massive variation in the perceived value—and the actual quality—of physical therapy care in this country. It also has further perpetuated the misconception that PTs “don’t play well with others”—and that doesn’t bode well for us as healthcare delivery moves toward a model of collaborative care. If we want to play on our patients’ healthcare teams, we have to be willing to play by the rules, and that means embracing standardized data collection tools. As far as outcome measures go, this means we must:

  1. Narrow down the set of tools used within our own industry, and
  2. Use tools that are recognizable and meaningful outside of physical therapy.

By establishing standards for the manner in which we collect and analyze our data, we make that data more credible—and more powerful. And that, in turn, allows us to form more accurate conclusions and projections. This represents a huge benefit, both inside of the clinic—by enabling us to better inform our patients of what they can expect throughout their therapy experience, for example—and outside of the clinic as we lobby for better payment rates and increased therapy utilization.

Of course, the other half of the standardization story is the push for interoperability—that is, the move toward an environment in which all healthcare providers use software systems that speak the same language, allowing data to flow seamlessly from one system to another. This not only increases the overall efficiency of healthcare delivery, but also lays the foundation for an effective episodic care model. This doesn’t necessarily mean we all have to use the same system; in fact, I think history has taught us that large, “one-size-fits-all” solutions do not meet the needs of most specialty providers, PTs included. Instead, I envision a connected network of niche-based software systems that fulfill their users’ specific workflow and compliance demands.

As you can probably tell, the discussions that unfolded during this year’s Graham Sessions were as diverse as they were provocative, and I left the meeting feeling inspired and invigorated. I also walked away with a renewed confidence—confidence that despite the many challenges we face, we have the knowledge, passion, and gumption necessary to not only overcome those challenges, but also catapult our profession to new heights.

About the Author

Heidi Jannenga, PT, MPT, ATC/L, Founder and COO of WebPT

As Chief Operating Officer, Heidi leads the product strategy and oversees the WebPT brand vision. She co-founded WebPT after recognizing the need for a more sophisticated industry-specific EMR platform and has guided the company through exponential growth, while garnering national recognition. Heidi brings with her more than 15 years of experience as a physical therapist and multi-clinic site director as well as a passion for healthcare innovation, entrepreneurship, and leadership.

An active member of the sports and private practice sections of the APTA, Heidi advocates for independent small businesses, speaks as a subject matter expert at industry conferences and events, and participates in local and national technology, entrepreneurship, and women-in-leadership seminars. Heidi is a mentor to physical therapy students and local entrepreneurs and leverages her platform to promote the importance of diversity, company culture, and overall business acumen for private practice physical therapy clinics.

Heidi was a collegiate basketball player at the University of California, Davis, and remains a life-long fan of the Aggies. She graduated with a BS in Biological Sciences and Exercise Physiology, went on to earn her MPT at the Institute of Physical Therapy in St. Augustine, Florida, and recently obtained her DPT through EIM. When she’s not enjoying time with her daughter Ava, Heidi is perfecting her Spanish, practicing yoga, or hiking one of her favorite Phoenix trails.

2 responses to “Lessons from the Graham Sessions: 4 Things PTs Must Do Now

  1. Than you for an informative post Heidi. I do have a nagging question. In your value formula how is access measured? It appears from the formula, that a small number assigned to access is value enhancing, so I am guessing that access is measured by days waiting for PT services or time spent in the PT waiting room by a patient or ???

  2. Hi Jim Sr.
    Thanks for the question and I apologize for not seeing this way earlier, but I guess its better late than never.
    You are correct in your assumptions as tot he smaller number enhancing the value. Because the formula is generic and high level, the actual data point entered into the equation is not specific – those that you indicated would work. The measurement would then be described in your outcome; ie: if you were solving for a more global outcome to an insurance company – I would suggest using the days waiting for PT services, but for a more internal review on your own clinic, it may be better to use a time spent in the waiting room metric.
    The main point of the equation is that PT “value” can be further enhanced by 2 values that previously have not been discussed and play a critical part in our value proposition as therapists.

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